| NPI | 1700834850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-13096) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 000247) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-06-27 |